- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $38.90 / $45.71
| Facility | 26 | $34.67 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $275.42 / $478.63
| Professional | | $218.78 | $275.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $141.25
| Professional | 26 | $22.91 | $34.67 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $426.58
| Professional | TC | $194.98 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $426.58 / $724.44
| Professional | | $371.54 | $426.58 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $45.71 / $77.62
| Professional | 26 | $41.69 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $380.19 / $645.65
| Professional | TC | $331.13 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $562.34
| Professional | | $436.52 | $512.86 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $45.71 / $46.77
| Professional | 26 | $44.67 | $45.71 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $416.87
| Professional | TC | $398.11 | $398.11 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $380.19 / $446.68
| Professional | | $354.81 | $380.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $47.86
| Professional | 26 | $38.02 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $354.81
| Professional | TC | $281.84 | $338.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $575.44
| Professional | | $245.47 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $51.29 / $57.54
| Professional | 26 | $26.30 | $51.29 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $426.58 / $512.86
| Professional | TC | $218.78 | $426.58 | $512.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $478.63 / $912.01
| Professional | | $380.19 | $478.63 | $912.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $87.10
| Professional | 26 | $36.31 | $48.98 | $87.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $426.58 / $812.83
| Professional | TC | $346.74 | $426.58 | $812.83 |